OSHA Opposes Mandatory Flu vaccination- NVAC Report 01-13-12
flu fighter conference 2018 #fluconf18 · Image result for phrc logo. No need to take notes…....
Transcript of flu fighter conference 2018 #fluconf18 · Image result for phrc logo. No need to take notes…....
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flu fighter conference 2019
#fluconf19
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WelcomeMichelle Wayt
Assistant Director, NHS Employers
#fluconf19
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The seven elements andflu vaccination uptake
Nathan Critchlow @n_critchlow,University of Stirling @StirUni
#fluconf19
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The seven benchmarks good practice:What are they, how are they used, and do they work?
Dr. Nathan Critchlow Institute for Social Marketing, University of Stirling
Flu Fighters Conference – 25th March 2019
E-mail: [email protected]: @n_critchlow
ISM
Institute forSocial Marketing
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No need to take notes….
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What factors influence flu vaccination uptake in healthcare staff?
Vaccination uptake among healthcare staff
Organisational factors:- Vaccination policy in trust
- Social and community norms about vaccination among healthcare staff
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Our study
• Anonymous survey of Flu Leads in NHS Trusts (England) in June-August 2017.
• Responses from 87 individual trusts (33% of all trusts) and 72 completed survey in full.
• No difference in responding and non-responding trusts (e.g. number of healthcare staff involved in direct patient care or uptake rate).
• 57% Acute Trusts, 25% Mental Health, 12% Community and 6% Ambulance. No area teams responded.
• Split sample into either ‘higher uptake’ (met 65% CQUIN minimum target; n = 57%) and ‘lower uptake’ (did not meet 65% CQUIN minimum target, n = 43%).
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What did we measure?
The survey was designed to capture a comprehensive overview ofeach trust’s flu campaign in 2016/2017 flu season, and whether theFlu Fighter benchmark criteria of good practice helped to explaindifferences between higher and lower uptake Trusts?
The Seven Key Benchmarks of Good Practice1. ‘Balanced flu team’ – Multidisciplinary team co-ordinated by a central flu lead.2. ‘Support from board to ward’ – Support at every level in the organisation.3. Communication – Keep staff updated throughout the campaign.4. ‘Mythbusting’ – To challenge misconceptions about vaccine.5. Accessibility – Making it easy to get the vaccine.6. Peer vaccinators – Make it easy to deliver vaccine in all staff groups.7. Rewards and incentives – A small treat can have a big impact.
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RESULTS
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Benchmark One - Having a balanced flu team.
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Benchmark Two - Support from ‘the board to the ward’
Perceived importance of fluvaccine uptake to executive &senior management in 2016/2017
…and to line and departmentmanagers in 2016/2017
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Benchmark Three - Comprehensive communications and ‘feedback loops’
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Benchmark Four – ‘Mythbusting’ activities
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Benchmark Five – Accessibility of the vaccine, by method of delivery
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Benchmark Five – Accessibility of the vaccine to staff group without significant disruption to their day
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Benchmark Six – Use of peer vaccinators
Between higher and lower uptake trusts, no difference in:
• Trusts using peer vaccinators
• Staff groups reached by peer vaccinators (see table).
• Incentives offered to staff to become peer vaccinators.
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Benchmark Seven – Incentives to be vaccinated for healthcare staff
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Do the findings support the seven benchmark criteria of best practice?
YESBM1: Balanced flu teamBM2: Support from board to the wardBM3: Comprehensive communicationsBM4: Making vaccine accessible to all staff groupsBM7: Offering incentives to be vaccinated
Practical implementation and design of Flu Campaign really matters! Components of the following benchmarks (BM) explained differences between higher and lower uptake trusts:
Although no differences for BM4 (mythbusting) and BM6 (peer vaccinators) mosthigher and lower uptake trusts already using these – so don’t reduce emphasis!
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More details….
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Many thanks ISMInstitute forSocial MarketingDr. Nathan Critchlow
Co-authors:
Martine Stead (ISM)
Anne Marie MacKintosh (ISM)
Sara Davis (ISM)
Fay Sullivan (NatCen)
Hayley Lepps (NatCen)
Rupal Patel (NatCen)
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Question time@n_critchlow,
@StirUni
#fluconf19
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Social care - bridging the gapJeanette Woods, Leeds Community
Healthcare NHS Trust @LCH_IPCand Kevin McGready,
Leeds City Council @lccpublichealth
#fluconf19
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Social care - bridging the gapKevin McGready
Adults and Health Directorate
Health Protection
Jeanette Wood
Infection Prevention and Control Nurse
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Influenza vaccination for social care staff
Context
• 15th October NHS England - support for social
care staff agreed
• In addition to social care staff, eligible in 2017-18,
health and care workers offering direct patient
care in the hospice sector were included
• To promote uptake in the wider cohort, NHS
England – North (Yorkshire and the Humber)
provided a one-off sum of £20,000 to Leeds City
Council
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The Campaign
1. Immunisation clinics
2. Baseline survey to support future influenza campaigns:
• Do you currently record staff influenza vaccine uptake?
• How many staff do you have?
• Do you know how many staff had their influenza vaccine?
• Do you record centrally resident influenza vaccine uptake?
• How many residents do you have?
• How many residents had their influenza vaccine?
• Where do you receive information from regarding influenza vaccine availability?
3. Development and support of local communications for the 19/20 campaigns
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Immunisation clinics
• 159 Care Homes, 12 Home Care providers and 3 Hospices
• 60 clinics were offered over a 2 week period - 19th and 26th November - a further 15 as a second opportunity in December
• A clinic booking form emailed - returns collated and a clinic schedule was developed
• 500 vaccines were ordered
• 23 clinics were booked including 2 Hospices and 2 Home Care providers (domiciliary services).
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Results
• The clinics were successful in immunising 254 additional social care staff that had not accessed existing arrangements with GPs or pharmacies.
• 4 sites had two clinics
• All sites found the extra support to be effective and well received.
• Certificates of Achievement presented to all participating sites and signed by the Director of Adult Social Care and the Director of Public Health.
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How do Leeds Community Healthcare NHS
Trust and Leeds City Council join up?
• NHS vaccinating council staff for 5 years
• 2016/17 750 council staff vaccinated
• 2017/18 1000 council staff vaccinated
• 2018/19 1000 council staff vaccinated
• 2018/19 health and social care staff - eventually all
council staff
• Feb 2019 144 additional council staff
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What is the overall vaccines given by
LCH NHS 2018/19?
End of January 2019 - 2980 total jabs given by NHS:
• 1960 NHS staff (with removed monthly denominators)
• 971 Council staff
• 144 Additional council staff
• 49 Other staff
• Over 1/3 of vaccines given to council
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How was it promoted?
• Council - in house promotion
• Electronic clinic schedule shared with council
teams
• Paper schedules shared around NHS bases and
health centres (next year will include A3 posters)
• Myth busting advice attached to schedule
leaflet
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How was it delivered?
• Piggy backed onto LCH vaccination campaign
• Back ground work – ordering vaccines, cold chain
storage, porta fridges, equipment, documentation,
PDG, admin, data input/devices, printing, reaction
management etc
• 7 reactions 2018/19 – 5 NHS, 1 Council and 1
care home
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• Scheduled clinics Oct – November 2018 - in
community integrated sites, NHS health centres
and bases
• 6 dedicated LCC sites early November
• Group events i.e. conferences and team
meetings
• Nurse walk arounds December - January 2019
• 2 add hoc full days in February 2019
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• Class nurse(s) – Imms and vac trained and
mandatory training completed
• Class nurse welcome session – walk through
procedure and PDG sign off
• Group email communication
• Resource file – contact details, procedure, access
to buildings, equipment check list etc
• Travel to clinics – porta fridges, trolley, devices,
sharps bins and back packs
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Plan for winter 2019/20
• Open to all council staff – Staff Welfare
• Estimated 3000 council staff vaccines
• Schedule - ½ - full day dedicated vaccination
clinics – council premises
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Question time
@LCH_IPC@lccpublichealth
#fluconf19
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Exhibition/networking20 mins
#fluconf19
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Motivation in healthcare worker’s flu vaccination
decisionsProfessor Gaëlle Vallée-Tourangeau
@ProfGaelle and Karis Moon @KarisMoon_, Kingston University @KingstonUni
@DARTresearch
#fluconf19
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Motivation in healthcare workers’ flu vaccination decisions Gaëlle Vallée-Tourangeau, professor of behavioural scienceKaris Moon, PhD candidate
@profgaelle
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Outline
1. Motors of HCWs flu vaccinations. (Gaëlle)2. Autonomous motivation. (Karis)3. Practical recommendations (Gaëlle)
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Why do we need behavioural decision research for flu vaccination in HCWs?
The problem The facts
Flu kills
You can spread flu to
others with no symptoms
Flu vaccination lowers the
risk of influenza infection
How people make decisions
You have scientific evidence for… But what about…
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Our research
This article outlines the development and
validation of a 9-item measure of
cognitive empowerment towards flu
vaccination (MoVac-flu scale) and an 11-
item measure of cognitive empowerment
towards vaccination advocacy.
Both scales were administered to 784
frontline NHS HCWs with direct patient
contact between June 2014 and July
2015.
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The problem with true facts and statistics
“I am needle phobic. I feel pressure from my manager to have it and I DO NOT WANT IT, IT IS MY CHOICE. RESPECT MY CHOICE AND DO NOT GUILT TRIP ME INTO HAVING IT.”
“I don’t really feel that it would benefit me.”
“I am healthy and don’t feel the need to get it.”
— MoVaC Survey respondents, June 2014 (emphasis added).
HCWs who did not take the flu vaccine were over 11 times more likely to mention the word “feel” in their choice justification compared to HCWs who got the flu jab.
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This conception misses two key important drivers: emotional and social influences.
Vallée-Tourangeau, G.,
Promberger, M., Moon, K.,
Wheelock, A., Sirota, M.,
Norton, C., & Sevdalis, N.
(2017). Motors of influenza
vaccination uptake and
vaccination advocacy in
healthcare workers:
Development and validation of
two short scales. Vaccine.
https://doi.org/10.1016/j.vaccin
e.2017.08.025
Beyond cognition: emotions and values
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Vallée-Tourangeau, G., Promberger, M., Moon, K., Wheelock, A., Sirota, M., Norton, C., & Sevdalis,
N. (2017). Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers:
Development and validation of two short scales. Vaccine.
https://doi.org/10.1016/j.vaccine.2017.08.025
Autonomy
The MoVac-flu tool9 validated questions to assess and monitor HCWs’ sentimentstowards flu vaccination.
KnowledgeImpactValue
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Flu vaccination is generally conceived as a decision under uncertainty driven by beliefs about the flu and flu vaccination.
One-unit increase in
the MoVac score
increases the odds
of vaccine uptake by
a factor of 9.78
The positive psychology of flu vaccination decisions
Source: 784 frontline NHS HCWs with direct patient contact between June 2014 and July 2015.
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Over to Karis
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The role of autonomous motivation in HCWs’ flu vaccination decisions Karis Moon, PhD candidate
@KarisMoon_
Supervisors:
Prof. Gaëlle Vallée-Tourangeau,
Dr. Amélie Gourdon-Kanhukamwe & Dr. Anine Riege
AutonomyKnowledgeImpactValue
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Overview
WHICH FEELINGS MOTIVATE BEHAVIOUR
COMMUNICATION CAN IMPACT EMOTION
NEXT STEPS
WHY AUTONOMY IS IMPORTANT
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Understanding Autonomy
• Better quality of behaviour.
• Increased persistence to engage.
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Flu Motivation534 respondents
44% were NHS Nurses
95% had direct patient contact
Example Items
Personal belief
I personally believe that having the
flu vaccine will protect my health.
Guilt avoidance
I would feel bad about myself if I
didn't get the flu jab.
External Pressure
I want my line-manager to think I'm
a good employee.
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Flu Motivation
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Promotional Health Messages can…
…increase negative attitudes
…reduce positive behavioural intentions
… provoke unintentional emotional responses
behavioural & cognitive effort to re-establish freedom.
accompanied by emotionReactance
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Next research steps
ConsiderMay
Opportunity
Could
Understand
We
Should
Duty
Responsibility
Must
Don’t BeOught
Autonomy Supportive High Controlling
Can the use of autonomy-supportive language reduce
perceived threat to autonomy?
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“Don't delay, book your flu jab early”
“You could be spreading flu right now”
“Don't let the ones you love become the ones you treat”
Next research steps
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Back to Gaëlle
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Thomson, A., & Watson, M. (2012). Listen, Understand, Engage. Science Translational Medicine, 4(138), 138ed6-138ed6.
https://doi.org/10.1126/scitranslmed.3004264
Beyond cognition: emotions and values
Community mobilisation,
public engagement,
social marketing
Active listening
Root cause analyses
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Implications for practice
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Implications for practice
Aim to increase perceived risk of flu infection
But be mindful of selective exposure and avoidance of information contradictory to one’s beliefs.
Focus efforts on line managers
Remember that staff who knew their managers was vaccinated were 5 times more likely to be vaccinated themselves.
Monitor and address context-specific drivers and barriers towards to cognitive empowerment
Increase perceived value, impact, knowledge, and autonomy for vaccination decisions
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Point your phone camera towards this square to join the Vaccination @ work network mailing list and get access to the free pdf version of this tool.
Contribute to research and help Karis by sharing her researchsurvey among your staff [email protected]
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Thank you!Acknowledgments
Angus Thomson, Christina Klein & Laura Millet (Sanofi Pasteur, Lyon); Michael Watson (Valera; formerly Sanofi Pasteur, Lyon) ; Nick Sevdalis & Ana Wheelock (Kings College, London); Marianne Promberger (formerly Kingston University London); Christine Norton (King’s college London); Anine Riege (Kingston University London); Amélie Gourdon-Kanhukamwe (Kingston University London)
@profgaelle | @KarisMoon_
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Panel to discuss opt outNicola Meredith,Public Health Wales
@PublicHealthWClaire Hobbs, Milton Keynes University
Hospital NHS Foundation Trust @MKHospitalAngela Lovell, Weston Area NHS Health Trust
@WestonNHS
Q&Achaired by Michelle
#fluconf19
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After lunch please go straight to your chosen workshop
Innovation in Point of Care Testing (POCT) for influenza diagnosis – Abbott
Chester suite
Leading changeDerby suite
Finding storiesVictoria suite
Seven Elements Living Gallery to share good practiceMain room
#fluconf19
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#fluconf19
Lunch/networking/exhibition1 hour
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Finding Stories Dawn Williams, Samantha Robinson, Helen
Robinson (AMBU Health Board) @AMBhealthand Joe O’Hagan (NHS Employers) @NHS_AV
#fluconf19
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Dawn Williams – Senior Nurse Manager
Occupational Health and Wellbeing Service
ABMU Heath Board @AMBhealth
Flu lead perspective: finding a story
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Our Flu Fighter Journey
Dawn Williams - Senior Nurse ManagerOccupational Health and Wellbeing Service
ABMU Heath Board
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Flu immunisation of Healthcare Workers protects them, their family, their patients and their colleagues
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Percentage of ABMU Staff Immunised
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Change in Strategy
• Worked closely with Communications team and Immunisation Co-ordinator to plan the campaign
From - Professionals responsibilities and Welsh Government Targets
To - Staff telling their stories, firmly basing the flu experiences of Health Board staff at the centre of the campaign
Aim – For staff to encourage and promote the flu vaccine
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Engaging With Your Workforce
Engaging with your Workforce
Accessibility of Vaccine -
walking the patch
Non-judgemental
approach
In house staff flu video and
photos
Emphasis on staff telling
stories
Staff bulletins encouraging comments
and debates
Use of social media
Training of flu champions /
peer vaccinators
Work closely with
colleagues
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Positive Impact on Campaign
• Increase in up-take amongst frontline staff
• Within the fist eight weeks of the campaign reached the Welsh Government target following a change of strategy
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How to Handle the Story
• Good communication skills
• Be visible, don’t shy away or be afraid to engage
• Be sensitive
• Use clinical evidence or facts to support dispelling myths
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Questions?
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Story giver perspective: how we became involved
Samantha Robinson and Helen Watts
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How we became involved with the Flu Campaign
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Why we chose to share our story
• To raise awareness of how anyone can be affected
• To show the comparison of one twin receiving the vaccination and the other not
• To dispel the myths of the vaccination
• Helping to prevent this happening to others
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Emotional Impact
• Very well supported by Dawn and the Flu Fighter Team
• Overwhelming response ‘going viral’!
• Initially, emotional/reliving the experience
• Frustration – people believing myths
• Being aware that not everyone who has experienced flu has such a positive outcome – sensitivity.
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Spreading the Word
• Flu leads/flu champions to look out for powerful stories
• Benefits of vaccination not just to patients but to staff members and their families
• Seeking opportunities to make presentations interesting/different
• Good relations with Communications Department – team work
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What this has meant to us personally
• Realisation of just how unwell the flu can make you
• The importance of ‘at risk’ groups being vaccinated
• The fear of potentially losing a loved one
• The anxiety/post traumatic stress that has resulted
• Immense gratitude to the NHS
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THANK YOU!
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Communications / AV perspective: producing the content
Joe O’Hagan - Senior AV Services Officer, NHS Confederation
@NHS AV
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Firstly it needs:
• A strong beginning
• Meaty middle
• Powerful ending
Think of it like a Hollywood film (lights, camera, action…)
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• Be an engaging story
• Have relevant characters
• Challenge the audience
• Have a substantial script
• And impactful music
Like a Hollywood film, it also has to…
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Themes used in the video*
• Imagine scenario
• Emotion – Research from Kingston University (https://www.nhsemployers.org/news/2018/11/emotion-is-key-in-encouraging-uptake-of-flu-vaccine)
• Personal instead of authoritarian - “Nurses' perception of being surrounded by an untrustworthy environment, which restricts their autonomy and seemingly is in opposition to their goal of maintaining a strong and healthy body. This illustrates the nurses’ perception of health authorities, pharmaceutical companies and scientists, which are often seen as opposing, non-trustworthy authorities.” (https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0215-5)
*(although these can be applied to any form of comms…)
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• Family… particularly children
• Archive
• Lifestyle
(Salford CCG Stay Well This Winter video campaign 2016)
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What can we offer?
• Digital Diaries - https://t.co/5w7P2JIeu9
• Hire out our services – www.nhsemployers.org/av
• Follow us on Twitter @NHS_AV
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Activity:
We would like to split you into groups of three to represent the three different perspectives of flu lead, communications, story-giver.
In your groups you will explore the hypothetical scenario you'll be given from this perspective.
We will come back together in the room to share answers and feedback.
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Leading ChangeAliya Rehman and Steph Foley
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Flu leads as leaders
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Kotter’s 8 step change model
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Over to you!
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Innovation in Point of Care Testing (POCT) for influenza diagnosis
Stephanie Carson from Abbott @AbbottGlobaland Dr. Raza from Sheffield Teaching Hospital NHS
Foundation Trust @SheffieldHosp
#fluconf19
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Dr Mohammad Raza MRCP FRCPath
Consultant Medical VirologistSheffield Teaching Hospitals NHS Foundation Trust
Influenza Burden: Unblocking the blocked resources:
New technology to the rescue?
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Talk Outline
• Winter Pressures and POCT testing • Key findings from our study• Our POCT experience • Lessons learnt and future strategies
• Important Note:POCT
– Within 300 yards of patients– Outside Labs– Performed by non-lab staff– Rapid TAT
9725/03/2019 Flu Fighters Conference
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• Alere i evaluation study performed independently
• One off Expert advisory role for Alere
• Talks sponsored by Alere/Abbott
98
Disclaimer
25/03/2019 Flu Fighters Conference
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9925/03/2019 Flu Fighters Conference
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100
• Direct effects of winter weather include an increase in incidence of:– heart attack
– stroke
– respiratory disease
– influenza
– falls and injuries
– hypothermia
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101
http://www.nuffieldtrust.org.uk/publications/whats-behind-ae-crisis
25/03/2019 Flu Fighters Conference
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102“Understanding Winter Pressures in A&E Departments” http://www.england.nhs.uk/wp-content/uploads/2014/10/wint-press-rep-2014.pdf
“The major issue centres on emergency admissions and the number of people requiring hospital care predominantly with respiratory conditions or decompensating other conditions – for example the failure of the heart to maintain adequate blood circulation, after long-standing vascular disease - usually brought on by cold weather and viruses”
25/03/2019 Flu Fighters Conference
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• 1/3rd of Winter related illnesses: Infections– Respiratory predominantly
– Main cause Influenza
• Primary prevention: Active immunisation
• Natural history of uncomplicated influenza– Target this group and avoid admissions
– Diagnose and send them home with short LOS (Length of Stay)?
104
Reducing the Flu burden
40,074 episodes: 3months3878 Flu features (2017/18)Local Sheffield data
25/03/2019 Flu Fighters Conference
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• Front line workers– High volumes of work– Need to meet targets– Rapid decisions– Patient flow
• Traditional diagnostic tools– diagnostic tools for high impact conditions (Troponin)– Antibody testing by CFT ~14-21 days– Culture: ~5 days– PCR tests gold standard but takes days to report
105
Front line work and diagnosis
25/03/2019 Flu Fighters Conference
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106
• Clinical diagnosis Sens 36%, Spec 78%• EMR Final Diagnosis Sens 26%, Spec 97%• ILI Sens 31%, Spec 88%
Only 36% infleunza positive patients received treatment
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107
only 16% of patients with laboratory-confirmed influenza received antiviral treatment30% were prescribed one of three common antibiotics
19% of patients at high risk presenting within 48 hrs
25/03/2019 Flu Fighters Conference
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• High grade fever
– Consultant level decision
– Default
– Referral, delays, admissions, discharge
108
Clinical Dilemma
25/03/2019 Flu Fighters Conference
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110
Positive results in 15 minutesHands on time not more than 3 min
25/03/2019 Flu Fighters Conference
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Newcastle In Vitro Diagnostics Co-operative
Rapid, near patient test (NPT) forFlu A & B
Clinical performance evaluation of a rapid nucleic acid amplification near patient test for Influenza A and B.
Recruitment – Winter 14/15• Multicentre study (4 sites)• Target ~800 patients
• Primary aim: sensitivity and specificity of Alere™ i NPT in the UK NHS• Secondary aims:
- Impact of rapid test on use of assessment suite isolation facilities and onward transmission of influenza.
- Cost-consequences.
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Newcastle In Vitro Diagnostics Co-operative
Data recorded
• Time to result reference test (standard laboratory test) and the index test (AlereNPT test).
- Time to standard test result 2.8 days vs. 15 minutes (Alere NPT).
• Isolation precautions used.
• Antivirals given.
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Newcastle In Vitro Diagnostics Co-operative
Turn around time of results
• Time delay for standard lab test result in
• District general Hospital:> 5 days
• Hosp with offsite lab:> 40 hours
• Hosp with onsite lab:>25 hours
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Newcastle In Vitro Diagnostics Co-operative
Data recorded
• Time to result reference test (standard laboratory test) and the index test (AlereNPT test).
- Time to standard test result 2.8 days vs. 15 minutes (Alere NPT).
• Isolation precautions used.
– 75% (68/91) of patients with influenza, were not isolated
– 69% (343/489) of patients without influenza, were isolated. Sensitivity = 75% (95% CIs: 64.53% - 83.25%), Specificity = 70% (95% CIs: 65.87% - 74.17%))
• Antivirals given.
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Newcastle In Vitro Diagnostics Co-operative
Data recorded
• Time to result reference test (standard laboratory test) and the index test (AlereNPT test).
- Time to standard test result 2.8 days vs. 15 minutes (Alere NPT).
• Isolation precautions used.
– 75% (68/91) of patients with influenza, were not isolated
– 69% (343/489) of patients without influenza, were isolated.
• Antivirals given.
- 54% (49/91) of patients with influenza, were given antivirals
- 12% (59/498) of patients without influenza, were given antivirals.
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Results:Cost analysis
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• Cost associated with diagnosis & management of Flu MODELLED
• Hypothetical cohort of 1000 patients
• Total cost of testing– Cost of isolation
– Antiviral prescriptions
– Prophylaxis for exposed patients
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25/03/2019 Flu Fighters Conference 118
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https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-018-0031-8
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Putting Alere i into practice
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Why should we diagnose Flu
• Uncomplicated cases could be safely sent home
• Earlier start of treatment has prognostic implications
• Control nosocomial spread of infection
• Targeted antivirals
• Antibiotic stewardship
• Rationalise use of side room facilities
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122
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
0 200 400 600 800 1000 1200
Series1Swab taken at Day x Post admission
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Point of Care Testing at STH
• 5 years experience of influenza PoCT
– From research to clinical service
• Start of Trust Flu season – PoCT deployed
(12th Dec-27th April)
– 14,146 RTPCR lab samples processed
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Winter preparation – key areas
• Clinical areas identified for PoCT– A&E
– Medical Assessment Centre (MAC)
– Medical Admissions Unit (MAU)
– Frailty Unit (FU) and Infectious Diseases (ID)
• Champions for each of those areas
• Engagement with the clinical support workers and nursing teams in those areas
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Point of care Team involvement
• They were essential and supported;
– Training
– Competency sign off
– Designed simple instructions
– Monitored stocks
– Point for trouble shooting
– Solve machines errors
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% Tests performed in each clinical area
A&E
MAC
AMU
FU
ID
Other
A&E: 39%
MAC: 15%
AMU: 17.5%
Frailty: 13%
ID: 5.5%
Other: 10%
Clinical usage
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Utilising IT resources
• Intranet/homepage information
– Declaration of the season & real time flu graphs
• Made additions on Lorenzo for ‘Flu flagging’
• Electronic referral pathway for ID patients
• Whiteboard infection control advice and PPE
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Increased EPR flags symptomatic patients
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Laboratory Results- Year on Year
2016-17
• 1st Dec -10th March (13 wks)
• 5,492 STH respiratory samples were processed
• 2,901 PoCT performed,
417 flu positive (14%).
• 18 Flu B, 374 Flu A and 25 dual
2017-18
• 12th Dec-27th April (19 wks)
• 8,754 STH respiratory samples were processed
• 4,069 PoCT performed,
976 flu positive (24%).
• 507 Flu B, 438 Flu A and 31 dual
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Declaration of flu season
Moving from the lab to the patient
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Patient information leaflet
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Patient information leaflet
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• This data includes Frailty unit and the average age of pts this winter was 65 (median 68) • We removed everyone flu + >3 days from admission to exclude nosocomial cases.
Average length of stay (LOS) Laboratory Positive cases of Influenza (n=540)
Swab taken <3 days of admission
POCT Done (Pathway followed) POCT Not Done (Pathway not
followed)
Age Groups POCT+ POCT- No POCT
All 5.75
n=235
7.87
n=106
7.56
n=199
<65 3.61
n=96
4.18
n=45
5.9
n=88
>65 7.28
n=139
10.69
n=61
8.87
n=111
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Infection Control Nurses
• Made sure there was guidance in each clinical area
• Signs and information with each instrument
• Designed a flu database for the management of all positives cases in the trust
• Active contact tracing and utiligy of the whiteboard
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Nosocomial data
• PoCT has a dramatic effect on infection control
• Clinical ops and nurse directors managing flu cohorting
• Significant increase in cohort wards • Only 2 cohort bays/wards in 2016-17
• 14 cohort bays/wards 2017-18
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Results:Cost analysis
@4000 POCT tests this equates to £860,000
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Further improvements
• Next generation (version 2) Alere i kits
– Early call out for positive results 5 min (neg in 13 minutes)
– Kit can now be stored at room temperature (fridge no longer required)
– Lowering of invalid results to <1%
138
Data from Kit manufacturer and kit insert
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Conclusions
• Technology has improved allowing accurate diagnosis of influenza
• Influenza results in as low as 5 min
• Rationalise use of precious public resources
• Have to break the ‘Too busy’ approach
• Leadership and vision
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Thank you-any questions?
Acknowledgements :
Frontline staff in ED/Medical Assessment Centre and Acute Medical Unit
Outbreak System Resilience Group
Point of Care Test Team
Infection Control Nurses
Laboratory staff
Clinical Virology Team
Sheffieldvirology.co.uk 14125/03/2019 Flu Fighters Conference
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Seven Elements Living Gallery to share good practice
Communications – Sussex Community NHS Foundation TrustAccessibility – University Hospitals of North Midlands NHS Trust
Support: all hands on Deck – Walsall Healthcare NHS TrustBalanced team – Sherwood Forest Hospitals NHS Foundation Trust
Myth busting – Wirral Community NHS Foundation TrustRewards – University Hospitals Bristol NHS Foundation Trust
Peer Vaccination – West Midlands Ambulance Service NHS Foundation Trust
#fluconf19
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Exhibition/networking20 mins
#fluconf19
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Behaviour changePaul Taylor-Pitt, Assistant Director at NHS
Employers @NHSE_Paul
#fluconf19
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Behaviour change:Why won’t they?
Paul Taylor-Pitt
#fluconf19
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#fluconf19
Environment
SelfOther
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#fluconf19
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#fluconf19
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#fluconf19
“
”
•Turn judgement into curiosity
•Turn disagreement into shared exploration
•Turn defensiveness into self-reflection
•Turn assumptions into questions. HSD Institute
Self as inquirer
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#fluconf19
Environment
SelfOthers
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Strategy
Capability
Culture
Structure
Systems
Engagement
Leadership
Skills
#fluconf19
Environment
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#fluconf19
EnvironmentEnvironment
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#fluconf19
Others
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#fluconf19
Others
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#fluconf19
Group is the unit of change
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“The success of any intervention depends entirely on the interior condition of the intervener”
– Otto Scharmer
Self
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#fluconf19
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#fluconf19
Using your voice
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#fluconf19
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#fluconf19
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Thank you for coming!Michelle Wayt, NHS Employers
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